Kodama N, Sasaki T, Yamanobe K, Kikuchi Y, Kurashima Y
No Shinkei Geka. 1986 Sep;14(10):1277-81.
There are two major approaches to basilar top aneurysm: one is subtemporal by Drake, another is pterional by Yasargil. In either approach, however, it is hazardous and difficult to approach basilar top aneurysm with megadolichobasilar anomaly because strong retraction of brain, nerve and vessel is required. A successful case of ruptured basilar top aneurysm with megadolichobasilar anomaly treated directly through the third ventricle is reported. A 62-year-old woman was admitted with consciousness disturbance. Plain CT scan on admission demonstrated massive and diffuse subarachnoid hemorrhage and a clot in the third ventricle. The left vertebral angiography demonstrated a 5 X 5 mm basilar top aneurysm with megadolichobasilar anomaly 24 mm distant from dorsum sellae. The aneurysm was considered to be inaccessible by conventional approaches because of its high position. Therefore, we have applied a new approach mentioned below. Operation was performed 2 days after the onset, using a bifrontal craniotomy. Dissecting interhemispheric fissure, we approached the third ventricle via lamina terminalis. Evacuating the clot in the third ventricle, the basilar top aneurysm was visualized. After dissecting the neck of aneurysm and perforators, clipping was performed. The postoperative course was uneventful. Surgical key points and prospective view in approaching via lamina terminalis and through the third ventricle for a high position basilar top aneurysm are discussed.
一种是德雷克（Drake）提出的颞下 approach，另一种是亚萨吉尔（Yasargil）提出的翼点 approach。然而，在这两种方法中，对于存在巨长基底动脉异常的基底动脉尖部动脉瘤，由于需要对脑、神经和血管进行强力牵拉，手术风险大且难度高。本文报道了一例通过第三脑室直接治疗破裂的伴有巨长基底动脉异常的基底动脉尖部动脉瘤的成功病例。一名62岁女性因意识障碍入院。入院时的头颅CT平扫显示广泛蛛网膜下腔出血及第三脑室内有血凝块。左侧椎动脉血管造影显示一个5×5mm的基底动脉尖部动脉瘤，伴有巨长基底动脉异常，距鞍背24mm。由于动脉瘤位置较高，传统方法难以触及。因此，我们采用了如下新方法。发病后2天进行手术，采用双额开颅术。通过分离大脑半球间裂，经终板进入第三脑室。清除第三脑室内的血凝块后，可见基底动脉尖部动脉瘤。分离动脉瘤颈部和穿支后进行夹闭。术后病程顺利。本文还讨论了经终板和第三脑室治疗高位基底动脉尖部动脉瘤的手术要点及前景。
